Meta

Examining the Migraine-Stroke Relationship

If a random sample of our population was challenged with describing a typical stroke survivor, what words would be used to construct such an image? I have actually asked this question of those around me in non-medical environments, curious as to what most people consider to be typical. “Paralyzed” is a common perception. “Slurred speech,” “unable to talk,” “can’t walk,” and “can’t move” are others. What I don’t often hear, though, is “refractory pain.” Strokes have been described as clinically silent, with the general perception being that a heart attack is painful, but a brain attack is not.

The reality is – every patient is different, and every stroke is different. Strokes can be painless, or they can be excrutiating, unrelenting, and painful beyond anything imaginable.

Over the coming months, I intend to write a series of posts addressing the issue of chronic pain following stroke – headaches, neck pain, scalp and facial pain, pain affecting arms and legs, thalamic pain syndrome. Pain can be quite prominent aftermath of stroke, especially in the younger stroke population. Often, these patients may have recovered well enough from a physical standpoint to receive numerous comments along the lines of: “You don’t look like you’ve had a stroke.” The response they may desire to give in return is: “You may think that, but I feel like I’ve had a stroke.”

To start the discussion, it is important to understand the relationship that exists between migraine and stroke.

So what is a migraine? This is another question I have posed to random individuals in non-medical settings, and I often ask patients who are experiencing headaches in the clinic what their idea of a migraine is. Often, the explanation involves the notion that a migraine is severe – a headache so intense that the person suffering with it must go to bed in a dark room devoid of sound and light.

Then, I tell them the truth about migraines: “A migraine is not a headache.”

The follow up to this is: “Migraine is an overly excited state in the brain, and a headache is very commonly associated with migraine, but a person can experience frequent migraines and never have a headache.”

Isn’t that interesting? A migraine that does not involve a headache is a strange concept to many. Some people have aura, an associated neurological symptom due to this “overly excited state,” such as seeing flashing lights, zigzag lines, or a smudge in the vision that grows into a large crescent of to engulf all visual fields, a phenomenon known as a scotoma.

Aphasic aura is an interesting migraine feature that is less common than visual aura or sensory aura, and very much can mimic a stroke at presentation. This involves the inability to speak clearly or potentially impaired understanding of language.

Migraine aura typically (but not always) resolves within an hour without medication, even if the associated headache lasts for hours or days. Other associated migraine symptoms include vertigo, tinnitus (ringing in the ears), nausea, confusion, and even fainting.

Migraine has long been established as a risk factor for stroke, particularly in young patients. The Collaborative Group for the Study of Stroke in Women published in 1975 that patients with migraine carried double the risk of stroke as patients without migraines. More recent data confirmed this risk. A French study found that there was no increased risk of stroke in elderly patients with migraines, while multiple studies have demonstrated an increased risk of stroke in the young migraine sufferer. Having migraine with aura carries an even higher relative risk of stroke than what is seen in patients with migraine who do not experience aura.

Consider this as well (I never miss an opportunity to preach about the dangers of cigarette smoking) – patients with migraine may carry twice the risk of stroke as patients without migraine, but patients with migraine who smoke cigarettes are ten times more likely to experience a stroke. Patients with migraine who smoke cigarettes and who use estrogen-containing birth control pills in one study were 34 times more likely to experience a stroke. I would encourage any migraine sufferer reading this who also uses birth control pills and who smokes to consider laying down the cigarettes and spending that money in other ways.

Why does having migraines increase one’s risk for stroke? Many theories exist, but the jury is still out on exactly why. It may be because the innermost lining of the arteries, called the endothelium, may differ from that which exists in the non-migraine population. It could have something to do with platelets (fragmented blood cells that assist in halting bleeding) functioning differently in migraineurs. Migraineurs are more susceptible to vasoconstriction, or spasming/squeezing in the arteries of the brain. The term for a stroke that occurs in the midst of a migraine episode is migrainous infarction.

Migraines can pose challenges to health care providers attempting to treat them in the young stroke population. Therapy for migraine is best broken down into two arms – abortive therapy, which is used as needed when migraines occur in order to gain relief, and preventative therapy, which is taken daily whether a migraine exists or not in an effort to decrease the frequency and severity of migraine episodes. Please check back for the upcoming post, covering the ground rules of treating migraine in the stroke patient.

7 comments

The typical response after meeting me is;
1. A neurologist – This guy needs to be in research.
2. OT – he knows more than me about stroke.
3. Stroke researcher – I hate it when a survivor is smarter than me.
I used to get migraines, probably from stress from my old job. Haven’t had one in years.

I’m a young survivor who had a stroke at age 50. Since that day I experience migraines daily. Sometimes they feel like sinus headaches, however after the migraine resolves I have numbness on the left side even more acutely. I was left with left side hemiplegia after each migraine my left side gets heavier to me. Now I understand why.

Seven years ago I survived an internal carotid artery dissection without stroke but with TIA-like symptoms and severe Horner’s syndrome, along with pulsatile tinnitus for a few weeks. The ICAD has left me with constant chronic headache which is mild to moderate, but occasionally severe, that no doctor has been able to explain. I know that other ICAD survivors have similar headache. What is your take on this residual headache after carotid artery dissection? What could be the cause? Is it “nerve damage” and if so, how is that causing headache?

What a great read. Greater understanding of these issues. Dealing with being post stroke (occipital lobe) having what I now understand as Aphasic Aura is uber difficult. For years (6) I’ve been trying to explain and make links to these issues. Going to a neuro without good results. Looked into photosensitive epilepsy with a neuro opthamologist but discovery that I am not with that issue. He got me to a vision therapist which answered a lot of where my issues stem from. Finally I feel that with all this info I have a grasp on my post stroke issues. Thanks for this read. Awesome!!

I have been diagnosed RCVS after series of scans for sudden vision change of blury left eye and Tia like symptoms. I’m taking verapamil for constriction and also flexeril now for neck pain said to be contractions of artery. It’s been over 3 months and I have lingering issues. Sporadic episodes daily of Ringing and pulse in ears, dizziness and when I have the sudden severe throb near temple comes in waves but stops as quick as it started followed by headache. That’s when I start getting weird symptoms again like you detailed above – not being able to say something like I’m stuck slight slur like drunk with intense fatigue like given sleeping pills! Also vision gets worse in eyes – and occasional numbness in right arm and side if face or tongue. Been told I have no stroke damage and no vision issue yet eye is blury! Confused what may be migraine vs vasoconstriction.

Migraine history in family, my migraines began at age 22 upon starting contraceptives, hemorrhagic stroke at 60. Remains with weak arm and leg, unable to walk without assistance. Pain on entire left side of body, painful to any touch

Yikes, I never knew about how close the connection of migraines and strokes were. I had suffered from migraines for 22+ years until discovering I have blepharospasm and therefore had to just watch what light I exposed myself too and how to avoid specific wavelengths. I recently read this about auras “most researchers do agree that two chemicals in the brain – serotonin and dopamine – play important roles in migraine development. Normally, these two chemicals work together to regulate mood and other functions of the brain. But researchers believe that in people who have migraine with aura, the chemicals work together to cause an overreaction that causes the blood vessels in the brain to dilate rapidly, resulting in an onrush of blood. In reaction, other chemicals are produced to help control the dilation of the vessels, causing vessels to contract. The dilation and contraction cycle in turn results in a throbbing and intensely painful headache.” (source: https://www.axonoptics.com/what-is-migraine-aura/). Definitely a complicated body mechanism that I think we stilll have so much to learn.

Meta

This site is for informational use only, and may not apply to your situation. No warranty is provided about the content or accuracy of any content. Neither the Publisher nor Author shall be held liable for any damages resulting from use of this information. All links are for information purposes only and are not warranted for content, accuracy, or any other implied or explicit purpose.